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Introduction

The quality of water in Viet Nam for handwashing with soap or other disinfectant solutions
is unknown. We assessed the risk for hand contamination and compared the efficacy
of five hand hygiene methods to remove bacterial contamination in a tertiary Vietnamese
hospital.

Methods

Five fingertip imprints of the dominant hand of 134 healthcare workers (HCWs) were
sampled to establish the average bacterial count before and after hand hygiene action
using: 1) alcohol-based handrub (ABHR); 2) plain soap and water handwashing with filtered
and unfiltered water; 3) 4% chlorhexidine gluconate (CHG) hand antisepsis with filtered
and unfiltered water.

Results

Average bacterial contamination of hands before hand hygiene was 1.65 log10. Acinetobacter baumannii, Klebsiella pneumonia, and Staphylococcus aureus were the most commonly isolated bacterial pathogens. Highest average count before
hand hygiene was recovered from HCWs without direct patient contact (2.10 ± 0.11 log10). Bacterial counts were markedly reduced after hand hygiene with ABHR (1.4 log10; p<0.0001) and CHG with filtered water (0.8 log10; p<0.0001). Use of unfiltered water was associated with non-significant reduction
in bacterial counts.

Conclusion

HCWs carry high levels of bacteria on their dominant hand, even without direct patient
contact. ABHR as an additional step may overcome the effect of high bacterial counts
in unfiltered water when soap and water handwashing is indicated.